What Factors Influence In-Hospital Mortality Following Aseptic Revision Total Hip Arthroplasty? A Single-Center Analysis of 13,203 Patients.

BACKGROUND

Revision total hip arthroplasty (rTHA) is associated with an extended surgical period, an increased hospitalization period, expanded blood loss, and high mortality rates. The purpose of the present study was to assess the risk factors that contribute to in-hospital mortality following aseptic rTHA.

METHODS

We performed a retrospective examination of the medical records of all patients who underwent elective rTHA surgery at our tertiary referral arthroplasty center between March 1996 and March 2019. The study involved a group of 13,203 patients, including 70 who expired during hospitalization and 13,133 in the control group. Baseline characteristics, medical history, comorbidities, and surgery-related parameters of the patients were recorded. Logistic regression analyses were performed to examine the association between independent variables and in-hospital mortalities, which were presented as odds ratios (ORs) and confidence intervals (CIs).

RESULTS

Patient factors associated with in-hospital mortality included hepatitis C (OR 75.5, 95% CI 3.5 to 1,625.2), chronic obstructive pulmonary disease (OR 30.7, 95% CI 6.5 to 145.7), rheumatoid arthritis (OR 28.9, 95% CI 3.8 to 218.5), history of myocardial infarction (OR 24.9, 95% CI 4.4 to 140.8), history of cerebrovascular disease (OR 23.1, 95% CI 3.8 to 142), congestive heart failure (OR 18.9, 95% CI 3.8 to 94.2), and diabetes mellitus (OR 10.2, 95% CI 2.4 to 42.6). Surgical factors included the history of multiple prior revisions (OR 1.75, 95% CI 1.1 to 2.7), postoperative blood transfusion (OR 2.8, 95% CI 1.1 to 7.3), and decreased preoperative hemoglobin (OR 2.3, 95% CI 1.7 to 3.1).

CONCLUSIONS

Several patient-related and intraoperative factors significantly increased the risk of in-hospital mortality following aseptic rTHA. Vigilance and close perioperative monitoring are essential for patients undergoing this complex surgery.

LEVEL OF EVIDENCE: III.